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WALMART PHARMACY 10-5169
DSH150065 SCHNECK MEDICAL CENTER
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Covered Entity Details
Entity Name
SCHNECK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150065
Entity Address
411 WEST TIPTON STREET
SEYMOUR, IN 47274
Medicare Provider Number
150065
Participating Start Date
10/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/15/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Ridlen, VP Finance/CFO
(812) 522-0170
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
1/15/2023
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